For the causes of this condition and for the prophylactic treatment based on a knowledge of these causes, reference may be made to catarrhal gastritis. The gastric and the intestinal disease arise in much the same way and they are often combined. But as might be expected from its position at the upper end of the alimentary canal, the stomach usually suffers first, and in greater degree. Toxic substances, however, in decomposing food may produce their greatest effect in the small intestine, the stomach escaping or being but slightly affected. Catarrhal enteritis may certainly arise under some unintelligible weather conditions, and little epidemics thus occur, presumably of bacterial origin.
Acute catarrhal enteritis is easily recognized. Its sudden beginning, often following a recognizable cause, its violence and the rapid recovery are characteristic features. Repeated attacks may occur, and some patients show a special liability. A chronic catarrhal enteritis is by no means common. The term was formerly applied to nearly every form of chronic intestinal disorder, but increasing knowledge has narrowed it down to a comparatively infrequent occurrence.
In the acute condition, if the stomach is simultaneously affected, abstinence from food should be practised as in acute gastritis. When diarrhoea is the prominent symptom from the first, food and drink may be given, but should be such as to leave little residue. Albumin-water and whey, with cold tea or barley-water to relieve thirst, are most suitable in the first stage. To these, brandy or sherry can be added if necessary. Raw meat-juice may also be needed in some cases.
As regards the next step, in slight cases the tendency to recovery after complete evacuation of the bowel is so strong that we may proceed rapidly by the addition of milk diluted with lime-water, and carbo-hydrates such as Benger's food, arrowroot, toast and rusks. Later eggs, pounded fish and sweetbread can be given with further varieties of starch, so that a plain full diet is often reached in a few days. The subsequent diet should be regulated with the idea of avoiding a recurrence.
But some cases are more prolonged and greater care is necessary. Though we speak of catarrhal enteritis as a clinical entity, it is probable that bacteriological varieties are included under this head. An important difference is to be noted in the character of the stools. They may be almost of rice-water appearance and nearly odourless, or they may be exceedingly offensive and suggest putrefaction of protein-material. In the former case it may be well to withhold milk and to allow very little carbohydrate until the trouble is abating. The diet then will consist of albumin-water, whey, raw meat-juice, panopepton (which may be made into a jelly) barley-water, tea, arrowroot made with water and boiled flour-gruel, in all of which alcohol can be given, if required.
Various irregularities of the bowels are grouped together under the term "chronic catarrhal enteritis" on the authority of Noth-nagel. There may be difference of opinion as to their nature and there may be a strong suspicion of a nervous element in some of them, but they are recognized conditions. Briefly, there are included here, (1) cases in which constipation regularly alternates with diarrhoea, the diarrhoeic stools being thin or soft, mixed with mucus and attended with pain, (2) cases in which there is a daily evacuation of unformed and pultaceous faeces, and (3) a continuing diarrhoea attributed by Nothnagel to an irritating excess of acidity in the small intestine, which occasions increased peristalsis, so that the contents of the small intestine are hurried to the anus, as is shown by the presence of unaltered bile-pigment in the stools.
In all such cases an attempt must be made to ascertain the actual defect, bacterial or otherwise, on which the diarrhoea depends. I doubt if the origin and nature of this group are sufficiently constant to warrant any dogmatic statement as to an appropriate diet. The history must be carefully examined. In chronic cases something can be learnt from the experience of the patient. He has often found out for himself the relative merits of a milk-carbo-hydrate and a protein diet. In every case the articles, which have been already mentioned as being harmful in diarrhoea, should be excluded. Certainly in some cases of continuing diarrhoea improvement will set in on such a nearly pure protein diet as the following : -
8 a.m.....Cocoa made with water, one or two eggs.
10 a.m.....Bouillon with an egg.
Noon.....Chicken or fish, piece of toast, custard.
Claret glass of Burgundy. 4 p.m.....Panopepton, one egg, piece of toast.
7 p.m.....Sweetbread, chicken, or fish, piece of toast.
Claret glass of Burgundy. 10 p.m. . . . Raw meat sandwiches or panopepton.
The diet recommended by Wegele may be quoted; -
Morning .... Cocoa, 200 grms.
One egg. Forenoon . . . Kefir (4 days old), 240 grms. Noon .... Soup, 250 grms.
Roast chicken, 150 grms.
Mashed potato, 250 grms.
2 p.m..... Cocoa, 250 grms.
6 p.m..... Kefir, 250 grms.
8 p.m..... Soup, 200 grms., one egg.
Sweetbread, 100 grms.
10 p.m..... Kefir, 250 grms.
During the day . Zwieback or toast, 75 grms.
Butter, 20 grms.
Whortleberry wine, 250 grms.